Download A Disease Crisis Strikes Russia

A Disease Crisis Strikes Russia: Russia and other Soviet successor
states are becoming the 'hot zones' of the Eurasian continent by
Murray Feshbach
At the press conference following the publication of the White Papers on
Environment and Health by the Russian government in October 1992, Dr. V.
Pokrovsky, the president of the Russian Academy of Medical Sciences, declared
that '" Russia is doomed for the next 25 years." After examining the data
contained in these reports, in other sources, and recent patterns of major increases
in infectious diseases, thyroid cancer, suicides, traumas and poisonings, murders,
declines in average life expectancy of both females as well as males, Pokrovsk's
statement can be taken as fully justified. In addition, new revelations almost every
month, if not week, add to the anthropogenic burden on the population of the
region. Given all the troubling signs amassed in this data, while it is hard to prove
that the gene pool of the Russian population is at risk, it is equally hard to deny it.
To wit: In the State Report on the Health Status of the Population of the Russian
Federation, one of the basic conclusions that impact on current and future health
noted that 75 percent of all women who carry to term have a pathology during
their pregnancy. Connected with this extraordinary pattern of late toxemia, sepsis,
and other problems is the report that only 40 percent of children born to these
women are healthy, and that 25 percent of them have rickets, anemia, or
hypotrophy during the first five years of life. With this disadvantaged start in life,
Russia's children have even tougher chances for healthy and proper development.
The air and water they consume each day are tainted with toxic industrial effluent,
and the food they eat lacks both quality and regulatory controls over its
production and processing. For children and adults alike, the environmental load
on their immune systems adds to their likelihood of becoming ill and/or receptive
to diseases.
Diminished Life Expectancy
It is now reported that only 4 percent of all children in St. Petersburg, perhaps 6
percent in Kiev, are " fully healthy." The definition is not precisely given but
seems to relate to the absence of chronic as well as acute illnesses among these
children. This is probably why we now have reports that in Russia only two-thirds
of 16-year-old males survive to age 60! If this is correct, it is a further worsening
over the last decade, when it was estimated for the beginning of the 1980s that
about 68 percent survived to that age (itself also a decline from 72 percent in the
mid-1960s).
No wonder then that life expectancy on the average for the Russian Federation's
males is now at about 63 years of age at birth, 73 for females. Probably even these
figures are too high. Internal projections prepared for the Russian Council of
Ministers anticipates a further two-year decline in life expectancy by the end of
the century. Even these projections are wrong because until 1993 the
methodology for calculating infant mortality was different from that of the World
Health Organization's standard methodology. As a consequence, if the WHO
methodology is fully implemented this year, as prescribed by the Russian
Statistical Agency, then the infant mortality rate will increase by some 25 to 33
percent for this reason alone.
In addition, internal projections prepared for the Russian Federation's Council of
Ministers projects that by the end of the century, life expectancy will decline to 67
for both sexes, with females below 73 and males, below 62, but in some areas at
least to 59 or lower. This is truly a major demographic catastrophe.
Moreover, given current patterns of infectious diseases, even these adjusted
projections may be too high. Deaths among the young are increasing from suicide,
alcohol abuse, drug addiction, and many other causes for more deaths at younger
ages.
The Rise of Infectious Diseases
Looking at infectious diseases, we see major outbreaks of diphtheria throughout
Russia, Ukraine, and Moldova-in some cases to a remarkable degree. In
Leningrad/St. Petersburg, the increase in diphtheria cases in the last three years,
and projected for 1993, is 70 times between 1990 and 1992, and 167 times by the
end of 1993 (if mid-year trends continued throughout the entire year). Moscow
has seen diphtheria increase to 2,000 cases as well. In Ukraine, 1,396 cases are
reported, of which 256 are children. Deaths of 12 children (7 from Kiev alone)
represent 13 percent of the 89 deaths recorded so far. Registered cases of
diphtheria have tripled in the last three years in Ukraine as a whole.
Diphtheria is an airborne disease spread from secretions of the infected.
Incubation is among the shortest of all diseases, with one to four days needed to
cause an infection. If antitoxin is not given immediately, serious illness to the
heart, lungs, or kidneys-or death-likely will ensue. In the former Soviet Union, 10
percent of all urban residents and 18 percent of all rural residents who contracted
the disease died as a consequence. In 1992, 129 persons died out of the total of
3,897 cases recorded in the Russian Federation. Higher rates of death, particularly
in the southern tier of the former Soviet Union, accounted for the higher ratios of
deaths shown for urban and rural residents. Current information is not available
for these former republics.
Although diphtheria is normally considered to be a childhood disease, over 70
percent (2,828) of recorded cases in 1992 were among persons 15 years or older;
and 1,069 cases were among children, ages 0 to 14 inclusive. More than onequarter of all childhood cases were recorded among those 7-10 years old (294
cases). With 90 percent of childhood cases and 86 percent of all adult cases
determined to be diphtheria gravis, clearly an epidemic prevails in the region.
A large part of the spread can be attributed to low immunization coverage.
Immunization ratios throughout all of the Russian Federation have declined to
below 70 percent for children and 45 percent for adults. A 90 to 95 percent
coverage ratio is necessary to prevent an epidemic. In Uzbekistan, the
immunization coverage overall is 40 percent. A massive campaign has been
introduced to bring the coverage of children up to 90 percent and adults to 70
percent by 1995. The domestic supply of vaccine probably will not cover more
than two-thirds by the time the campaign is supposed to be completed; imports
and/or donations by other countries and agencies, such as the $50 million for
vaccines from the European Union, are necessary to prevent the epidemic from
spreading.
But the worsening infectious disease situation in the former Soviet Union
encompasses other diseases as well. Typhoid is appearing in large numbers, up to
300 cases in one city (Volgodansk) alone, and the number will likely rise
alarmingly as the lack of wastewater treatment, poor water quality, and the
number of possible carriers all increase. Cholera is imported from Afghanistan by
refugees who had originally fled from Tajikistan and returned home, bringing
back cholera in their " baggage." In addition, cholera has been contracted in India,
Pakistan and Afghanistan. The 14 September 1993 report that there were also
indications of cholera in Kazakhstan is worrisome because it indicates the
potential for a major spread of the disease. Tourism to Kazakhstan has been
suspended. Estimates of cholera in Kazakhstan number from 5 cases up to 2,500
cases. The likelihood of more incidence in adjacent areas is high.
Tuberculosis could explode in cities as legal and illegal refugees, as well as forced
migrants fleeing from perceived and real dangers, continue to travel throughout
the region. Among the Kurdish, largely illegal refugees in the Moscow region, it
is believed that some 40 percent of the children have active tuberculosis. If true,
or even half true, then the potential for widespread TB infection is clear.
Inadequate Medical Services
The medical establishment is coping only up to a certain point. Rumors swirled
around Moscow in late August up to mid-September 1993 that another new
Minister of Health would be appointed shortly. Since the mid-1980s, very few
ministers have had a long tenure of more than several years. Shortages of
medicine as well as the spread of disease, corruption, the breakdown in medical
services outside of central facilities, mistrust of the quality of vaccines, the
ongoing skepticism about whether syringes and needles are sterilized or singleuse only, and the declining life expectancy probably all contribute to the rumor
mill. But this rumor may prove to be true. Foreign assistance can only go so far.
Internal reform and preparations for potential major epidemics are needed
urgently.
Murray Feshbach Is Research Professor of demography at Georgetown
University in Washington, D.C. Dr. Feshbach has written widely on health and
demographic problems In the former Soviet Union. This article was excerpted
from his forthcoming work, Russia's Environmental Degradation, published by
the Twentieth Century Fund.